Morton's Neuromas

A Neuroma is an enlarged nerve. A Morton’s Neuroma, the most common type in the foot, causes intense pain in the ball of the foot that shoots out to the third and fourth toes. Numbness, cramping and tingling in the 3rd or 4th toes is also common. The second and third toes can also be affected, but this is much more uncommon.

Symptoms:

  • The pain is typically the worse with standing and walking and is relieved by removing your shoes.
  • Some will complain of deep achy pain, others complain of constant burning and cramping.
  • There can be radiating pain, tingling pain or numbness.
  • Many people will describe the pain as feeling like they are walking on a lump or a ball.
  • A “twang” feeling, like a guitar string, is another common complaint.

Diagnosing:
A neuroma is diagnosed by good questioning and a physical exam of the foot by a podiatrist. Pressing on certain areas of the foot will reproduce the pain. Squeezing the foot together and pushing up under the nerve will, in many cases, yield a positive “Mulder’s Click”. The clicking feeling associated with pain shooting to the toes is diagnostic for a Morton’s neuroma.

Ways to get immediate relief from the pain:
Sitting down, taking off the shoe, wiggling the toes and massaging the foot generally gives relief. Constant irritation typically causes the nerve sheath to become enlarged. The nerve can become irritated when the foot is cramped in a shoe that is too tight or too flexible. Overuse can also cause the nerve to be injured and activities that generally irritate the nerve include going up and down hills or stairs, squatting and any type of running or jumping.

Common Treatments

  • A steroid injection will sometimes help to decrease pressure from the inflammation in the surrounding joints. But for extremely large neuromas, the additional fluid injected into the foot might cause more pressure on the nerve, which would cause more pain. If you do choose to have an injection, no more than 4 injections should be given in the same area in a 12 month period. If two injections have not helped it is not likely a third injection will.
  • Alcohol injections (also called nerve sclerosing) are another option.
  • Other conservative treatments include wider shoe gear, reduction in activity level, accommodative shoe inserts or prescription foot orthotics.
  • If none of the above therapies help, surgery is the next step. Surgery involves cutting the nerve and removing the small tumor or enlarged portion of the nerve. An area of permanent numbness will remain between the 3rd and 4th toes. The surgery is typically done at a surgery center and takes about 40- 45 minutes. The recovery time involves wearing a surgical shoe for 2-4 weeks and typically takes 4-6 for full recovery. One of the more common complications of the surgery is the development of a “stump” neuroma. The nerve can become entrapped in scar tissue at the site where it was cut and cause pain.
Call Central Carolina Foot and Ankle Associates at 919-477-9333 for an appointment or click the link below.

Central Carolina Foot & Ankle Associates

NORTH DURHAM
CENTRAL MEDICAL PARK
2609 N. Duke Street, Ste. 301
Durham, NC 27704
(near the corner of N. Duke St. and Stadium Dr.)
919-477-9333

SOUTHWEST DURHAM
HIGHGATE CENTRE
5107 Southpark Drive
Suite 202
Durham, NC 27713
(close to RTP and Chapel Hill)
919-544-2583